- Design
- Nationwide matched cohort with sibling comparison, Swedish registers
- Population
- 4,317 adults with GPA or MPA, 21,582 controls, 25,568 siblings
- Primary outcome
- Composite cardiovascular disease and thromboembolism
- Effect
- GPA HR 2.04, MPA HR 2.45; first 3 months HR 7.69 (5.93-9.99)
This Swedish nationwide register study compared 4,317 adults with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA), diagnosed 2005-2020, with 21,582 matched controls and 25,568 siblings.
Both GPA (HR 2.04) and MPA (HR 2.45) carried roughly double the risk of the composite of myocardial infarction, stroke, DVT, pulmonary embolism and related death. Risk peaked within three months of diagnosis (HR 7.69, 95% CI 5.93-9.99). In GPA, men had excess myocardial infarction (HR 2.25) and women excess ischaemic stroke (HR 1.64). Siblings had no excess risk.
The absence of risk in siblings points to the vasculitis itself, rather than shared genes or lifestyle, as the driver. The early peak coincides with active disease and high-dose treatment.
That makes the first three months the window for thromboprophylaxis decisions and cardiovascular risk review.
- Assess VTE risk at diagnosis and during any admission with active ANCA vasculitis.
- Consider thromboprophylaxis during the early high-risk period in hospitalised patients.
- Review blood pressure, lipids and smoking early, not only after remission.
- Have a low threshold to investigate chest pain, leg swelling or breathlessness in the first months.
Why it matters
It locates the excess risk in a specific early window when intervention is most likely to help.
Don't overread it
Events came from registry codes, and the study cannot show whether prophylaxis in this window reduces events.
The statistics, in plain English
A hazard ratio of 7.69 in the first three months means events were nearly eight times as frequent as in matched controls during that period. Sex-specific findings come from subgroup analyses and are less certain than the overall result.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for rheumatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free